Browsing by Author "Zivanic, Aleksandra (57215494207)"

Background: Electrocardiographic (ECG) indices, such as the morphology-voltage-P-wave (MVP) score, and echocardiographic parameters like left atrial volume index (LAVi), left atrial reservoir strain (LASr), and left atrial appendage (LAA) emptying velocity (LAAev) are associated with atrial fibrillation (AF) risk. However, the relationships between these markers remain incompletely understood. Aims: This study aimed to investigate correlations between the ECG MVP score and echocardiographic indices of LA size and function. Methods: In this prospective study, 60 patients in sinus rhythm, including 8 patients with paroxysmal AF, scheduled for transesophageal echocardiography underwent a 12‑lead ECG and transthoracic echocardiography within 30 min. Results: Significant correlations were observed between the mitral E/e’ ratio and LAVi (r = 0.30, p = 0.029), LASr (r = −0.42, p = 0.002), and LAAev (r = −0.29, p = 0.037). In comparison to patients with mid-high MVP scores, LAAev was significantly lower in those with low MVP scores (49 ± 21 vs. 61 ± 23 cm/s, p = 0.027). No significant differences were observed between the groups in LAVi (40 ± 20 vs. 42 ± 12 ml/m2, p = 0.187), LASr (26 ± 11 vs. 25 ± 10 %, p = 0.967), or mitral E/e’ ratio (8.2 ± 1.6 vs. 7.3 ± 1.3, p = 0.876). Additionally, patients with paroxysmal AF had significantly lower LASr and higher mitral E/e’ ratio compared to those without paroxysmal AF. Conclusions: While LAVi, LASr, and LAAev were all related to noninvasively assessed left ventiricular (LV) filling pressure, only LAAev was able to differentiate risk categories based on the MVP score. Our findings suggest that a multiparametric approach to evaluating LA and LAA function, and LV filling pressures may offer a more comprehensive assessment of AF risk than using individual parameters. © 2025 Elsevier Inc.

Cardiac ultrasound (CUS), either focused cardiac ultrasound (FoCUS) or emergency echocardiography, is frequently used in cardiovascular (CV) emergencies. We assessed correlations and discrepancies between CUS, clinical diagnosis and the autopsy findings in early deceased patients with suspected CV emergencies. We retrospectively analysed clinical and autopsy data of 131 consecutive patients who died within 24 h of hospital admission. The type of CUS and its findings were analysed in relation to the clinical and autopsy diagnoses. CUS was performed in 58% of patients - FoCUS in 83%, emergency echocardiography in 12%, and both types of CUS in 5% of cases. CUS was performed more frequently in patients without a history of CV disease (64 vs. 40%, p = 0.08) and when the time between admission and death was longer (6 vs. 2 h, p = 0.021). In 7% of patients, CUS was inconclusive. In 10% of patients, the ante-mortem cause of death could not be determined, while discrepancies between the clinical and post-mortem diagnosis were found in 26% of cases. In the multivariate logistic regression model, only conclusive CUS [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30–7.39, p = 0.044] and chest pain at presentation (OR 30.19, 95%CI 5.65 -161.22, p < 0.001) were independently associated with congruent clinical and autopsy diagnosis. In a tertiary university hospital, FoCUS was used more frequently than emergency echocardiography in critically ill patients with suspected cardiac emergencies. Chest pain at presentation and a conclusive CUS were associated with concordant clinical and autopsy diagnoses. © The Author(s), under exclusive licence to Springer Nature B.V. 2024.

Background: Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose: To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods: This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%–60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results: Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m2, respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m2 exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion: There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. © RSNA, 2024.